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Limit on Medicare RAC records requests increased; SNFs to provide more documentation

March 20, 2012
by Kevin Kolus
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In a notice last week on the Medicare Fee-for-Service Recovery Audit Program, the Centers for Medicare & Medicaid Services increased the number of medical records that can be requested by Recovery Audit Contractors (RACs) from providers.

The annual limit, based on claims volume only, is now 2 percent of claims submitted in the prior calendar year and divided by 8—up from 1 percent of claims previously. RACs are now allowed to request a maximum of 400 medical records in a 45-day period, up from 300 under the previous rulemaking.

Skilled nursing providers must also provide documentation for Medicare beneficiaries’ entire episodes of care—from admission to discharge—during a RAC records request, according to the CMS notice.

The notice indicated that RACs may receive permission to exceed the records request limit “by CMS’s own initiative or from the Recovery Auditor requesting permission.”

“CMS or the Recovery Auditor will notify affected providers in writing,” the notice read.

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